THE progress of the healing art, as distinguished from certain sterile branches of medical science, can be best measured by the progress of our insight into the causes of special maladies. For the accidental discovery of a "specific" means generally nothing but the discovery of a method for suppressing special symptoms of a disease. Quinine subdues chills, but does not prevent a relapse of febrile affections; brandy neither cures nor subdues dyspepsia, but merely interrupts it with a transient alcohol-fever. But, as soon as we ascertained that scrofula, or the "king's-evil," was not caused by a mysterious dispensation of Providence, but by bad food and foul air, the cure of the disease became easy enough; the king's-evil disappeared without the aid of the king.

That "colds," or catarrhal affections, are so very common—so much, indeed, as to be considerably more frequent than all other diseases taken together—is mainly due to the fact that the cause of no other disorder of the human organism is so generally misunderstood. Few persons have recognized the origin of yellow fever; about the primary cause of asthma we are yet all in the dark; but in regard to "colds" alone the prevailing misconception of the truth has reached the degree of mistaking the cause for a cure, and the most effective cure for the cause of the disease. If we inquire-after that cause, ninety- nine patients out of a hundred, and at least nine out of ten physicians, would answer, "Cold weather," "Raw March winds," or "Cold draughts," in other words, out-door air of a low temperature. If we inquire after the best cure, the answer would be, "Warmth and protection against cold draughts"—i. e., warm, stagnant, in-door air. Now, I maintain that it can be proved, with as absolute certainty as any physiological fact admits of being proved, that warm, vitiated indoor air is the cause, and cold out-door air the best cure, of catarrhs. Many people "catch cold " every month in the year and often two or three times a month. Very few get off with less than three colds a year; so that an annual average of five catarrhs would probably be an underestimate. For the United States alone that would give us a yearly aggregate of two hundred and fifty-five million "colds." That such facilities for investigation have failed to correct the errors of our exegetical theory is surely a striking proof how exclusively our dealings with disease have been limited to the endeavor of suppressing the symptoms instead of ascertaining and removing the cause. For, as a test of our unbiased faculty of observation, the degree of that failure would lead to rather unpronounceable conclusions. What should we think of the scientific acumen of a traveler who, after a careful examination of the available evidence, should persist in maintaining that mosquitoes are engendered by frost and exterminated by sunshine? Yet, if his attention had been chiefly devoted to the comparative study of mosquito-ointments and mosquito-bars, he might, for the rest, have been misled by such circumstances as the fact that mosquitoes abound near the ice-bound shores of Hudson Bay, and are rarely seen on the sunny prairies of Southern Texas. In all the civilized countries of the colder latitudes, catarrhs are frequent in winter and early spring, and less frequent in midsummer: hence the inference that catarrhs are caused by cold weather, and can be cured by warm air. Yet of the two fallacies the mosquito theory would, on the whole, be the less preposterous mistake; for it is true that long droughts, by parching out the swamps, may sometimes reduce the mosquito-plague, but no kind of warm weather will mitigate a catarrh, while the patient persists in doing what thousands never cease to do the year round, namely, to expose their lungs, night after night, to the vitiated, sickening atmosphere of an unventilated bedroom. "Colds" are, indeed, less frequent in midwinter than at the beginning of spring. Frost is such a powerful disinfectant that in very cold nights the lung-poisoning atmosphere of few houses can resist its purifying influence; in spite of padded doors, in spite of "weather-strips" and double windows, it reduces the in-door temperature enough to paralyze the floating disease-germs. The penetrative force of a polar night-frost exercises that function with such resistless vigor that it defies the preventive measures of human skill; and all Arctic travelers agree that among the natives of Iceland, Greenland, and Labrador pulmonary diseases are actually unknown. Protracted cold weather thus prevents epidemic catarrhs, but during the first thaw [1] Nature succumbs to art: smoldering stove-fires add their fumes to the effluvia of the dormitory, tight-fitting doors and windows exclude the means of salvation: superstition triumphs; the lung-poison operates, and the next morning a snuffling, coughing, and red-nosed family discuss the cause of their affliction. "Taken cold"—that much they premise without debate. But where and when? Last evening, probably, when the warm south wind tempted them to open the window for a moment. Or "when those visitors kept chatting on the porch, and a drop of water from the thawing roof fell on my neck." Or else the boys caught it by playing in the garden and not changing their stockings when they came home. Resolved, that a person can not be too careful, as long as there is any snow on the ground. But even that explanation fails in spring; and, when the incubatory influence of the first moist heat is brought to bear on the lethargized catarrh-germs of a large city, a whole district-school is often turned into a snuffling-congress. The latter part of March is the season of epidemic colds.

The summer season, however, brings relief. In the sweltering summer nights of our large sea-board towns the outcry of instinct generally prevails against all arguments of superstition; parents know that their boys would desert and sleep in a ditch rather than endure the horrors of an air-tight sweat-box; so the windows are partially-opened. The long, warm days also offer increased opportunities for out-door rambles. In midsummer, therefore, Nature rallies once more. But not always. There are people whose prejudices can not be shaken by experience, and in their households a perennial system of air-poisoning overcomes the redeeming tendencies of out-door life, as the subtile mixtures of La Brinvilliers overcame the iron constitution of her last husband. Their children snuffle the year round; no cough-medicine avails, no flannels and wrappers, even in the dog-days; and the evil is ascribed to "dampness," when the cold-air theory becomes at last too evidently preposterous.

To an unprejudiced observer, though, that theory is equally untenable in the coldest month of the year. No man can freeze himself into a catarrh. In cold weather the hospitals of our Northern cities sometimes receive patients with both feet and both hands frozen, with frost-bitten ears and frost-sore eyes, but without a trace of a catarrhal affection. Duck-hunters may wade all day in a frozen swamp without affecting the functions of their respiratory organs. Ice-cutters not rarely come in for an involuntary plunge-bath, and are obliged to let their clothes dry on their backs: it may result in a bowel-complaint, but no catarrh. Prolonged exposure to a cold storm may in rare cases induce a true pleural fever, a very troublesome affection, but as different from a "cold" as a headache is from a toothache—the upper air-passages remain unaffected. Sudden transition from heat to cold does not change the result. In winter the "pullers " of a rolling-mill have often to pass ten times an hour from the immediate neighborhood of a furnace to the chill draught of the open air; their skin becomes as rough as an armadillo's, their hair becomes grizzly or lead-colored; but no catarrh. On my last visit to Mexico, I ascended the peak of Orizaba from the south side, and reached the crater bathed in perspiration; and, following the guide across to the northwest slope, we were for ten minutes exposed to an ice-storm that swept the summit in blasts of fitful fury. Two of my companions, a boy of sixteen and an old army-surgeon, were not used to mountain-climbing, and could hardly walk when we got back to our camp in the foot-hills, but our lungs were none the worse for the adventure. Dr. Franklin, who, like Bacon and Goethe, had the gift of anticipative intuitions, seems to have suspected the mistake of the cold-air fallacy. "I shall not attempt to explain," says he, "why damp clothes occasion colds, rather than wet ones, because I doubt the fact; I believe that neither the one nor the other contributes to this effect, and that the causes of colds are totally independent of wet and even of cold" ("Miscellaneous Works," p. 216).

"I have, upon the approach of colder weather, removed my undergarments," says Dr. Page, "and have then attended to my out-door affairs, minus the overcoat habitually worn; I have slept in winter in a current blowing directly about my head and shoulders; upon going to bed, I have sat in a strong current, entirely nude, for a quarter of an hour, on a very cold, damp night, in the fall of the year. These and similar experiments I have made repeatedly, and have never been able to catch cold. I became cold, sometimes quite cold, and became warm again, that is all" ("Natural Cure," p. 40).

There are many ways, less often sought than found, for "becoming quite cold, and warm again," but an experimenter, trying to contract a catarrh in that way, would soon give it up as a futile enterprise; after two or three attempts he would find the attainment of his purpose more hopeless than before; he would find that, instead of impairing, he had improved the functional vigor of his breathing-apparatus. Cold is a tonic that invigorates the respiratory organs when all other stimulants fail, and, combined with arm-exercise and certain dietetic alteratives, fresh, cold air is the best remedy for all the disorders of the lungs and upper air-passages. As soon as oppression of the chest, obstruction of the nasal ducts, and unusual lassitude indicate that a "cold has been taken"—in other words, that an air-poison has fastened upon the bronchi—its influence should at once be counteracted by the purest and coldest air available, and the patient should not stop to weigh the costs of a day's furlough against the danger of a chronic catarrh. In case imperative duties should interfere, the enemy must be met after dark, by devoting the first half of the night to an out-door campaign, and the second half to an encampment before a wide-open window. If the fight is to be short and decisive, the resources of the adversary must be diminished by a strict fast. Denutrition, or the temporary abstinence from food, is the most effective, and at the same time the safest, method for eliminating the morbid elements of the system; and there is little doubt that the proximate cause of a catarrh consists in the action of some microscopic parasite that develops its germs while the resistive power of the respiratory organs is diminished by the influence of impure air. Cold air arrests that development by direct paralysis. Toward the end of the year a damp, sultry day—the catarrh-weather par excellence—is sometimes followed by a sudden frost, and at such times I have often found that a six hours' inhalation of pure, cold night-air will free the obstructed air- passages so effectually that on the following morning hardly a slight huskiness of the voice suggests the narrowness of the escape from a two weeks' respiratory misery. But, aided by exercise, out-door air of any temperature will accomplish the same effect. In two days a resolute pedestrian can walk away from a summer catarrh of that malignant type that is apt to defy half-open windows. But the specific of the movement-cure is arm-exercise—dumb-bell swinging, grapple-swing practice, and wood-chopping. On a cold morning (for, after all, there are ten winter catarrhs to one in summer), a wood-shed matinéeseems to reach the seat of the disease by an air-line. As the chest begins to heave under the stimulus of the exercise, respiration becomes freer as it becomes deeper and fuller, expectoration ceases to be painful, and the mucus is at last discharged en masse, as if the system had only waited for that amount of encouragement to rid itself of the incubus. A catarrh can thus be broken up in a single day. For the next half-week the diet should be frugal and cooling. Fruit, light bread, and a little cold, sweet milk, is the best catarrh-diet. A fast-day, though, is still better. Fasting effects in a perfectly safe way what the old-school practitioners tried to accomplish by bleeding; it reduces the semi-febrile condition which accompanies every severe cold. There is no doubt that by exercise alone a catarrh can gradually be "worked off." But in-doors it is apt to be steep up-hill work, while cold air—even before the season of actual frosts—acts upon pulmonary disorders as it does upon malarial fevers: it reduces them to a less malignant type.

A combination of the three specifics—exercise, abstinence, and fresh air—will cure the most obstinate cold; only, the first signs of improvement should not encourage the convalescent to brave the atmosphere of a lung-poison den. So-called chronic catarrhs are, properly speaking, a succession of bronchial fevers. The popular idea that an average "cold" lasts about nine days, has some foundation in truth. Like other fevers, catarrhs have a self-limited period of development, but the recovery from the first attack constitutes no guarantee against an immediate relapse; on the contrary, the first seizure appears to prepare the way for its successors. A long sojourn in an absolutely pure atmosphere, as in a summer camp on the mountains, seems for a while to make the lungs catarrh-proof, by increasing the vigor of their resisting ability, and the returned tourist may find to his surprise that the air of his family den can now be breathed without the wonted consequences. But the addition of a stove or a double window at last turns the scales against Nature, and the first malignant cold reproduces the sensitiveness of the respiratory organs.

After recovery from a chronic catarrh the danger of contagion should therefore be carefully avoided. In many of our Northern cities ill-ventilated reading-rooms are veritable hot-beds of lung-poison, as crowded court-rooms in the villages, and taverns and quilting-assemblies in the backwoods. Meeting-houses, with their large windows and small, rarely-used stoves, are less dangerous; but stuffy school-rooms are as prolific of colds as swamps of mosquitoes, and often counteract all sanitary precautions of the domestic arrangements. Stuffed railway-cars, too, could claim a premium as galloping-consumption factories; and after dark the retreat to an over-heated "Pullman sleeper" would hardly increase the chances of longevity; the best plan for long-distance travelers would, on the whole, be to secure a rear seat, where open windows are less apt to awaken the groans of air-fearing fellow-passengers, and risk cinders and smoke rather than the miasma of the galloping man-pen.

It would be a mistake to suppose that "colds" can be propagated only by direct transmission or the breathing of recently vitiated air. Catarrh-germs, floating in the atmosphere of an ill-ventilated bedroom, may preserve their vitality for weeks after the house has been abandoned; and the next renter of such a place should not move in till wide-open windows and doors and a thorough draught of several days has removed every trace of a "musty" smell.

If a bronchial catarrh is accompanied by a persistent cough, it indicates that the affection is deep-seated, and that it has probably spread to the upper lobes of the lungs. Arm-exercise and a mild, saccharine diet generally suffice to loosen the phlegm and thereby remove the proximate cause of the evil. But, if those remedies fail, there is a presumption that the chronic character of the affection is due to a permanent external cause of irritation, which can be removed only by a change of air. In such cases cough-sirups merely palliate the evil. Medicines, counter-irritants, and fasting are in vain, if the lungs of the patient are constantly impregnated with new morbific germs; even exercise can do little more than alleviate the distress of the symptoms; a radical cure is impossible as long as every night undoes the work of the preceding day. In a home of prejudices the patient should at once change his bedroom and take care to profit by the change.

A neglected catarrh may result in an attack of pleurisy. Each lung is inclosed in a sack-like serous membrane, which connects with a similar membrane lining the inner surface of the chest. This double integument, known as the pleura, or the visceral and parietal layer of the pleural membrane, communicates both with the lungs and with the upper air-passages, and is more or less affected by every morbid condition of the respiratory organs. Pleurisy, or the congestion of the pleural membrane, is generally an inflammatory complication of a chronic catarrh. The original affection may have apparently subsided. Counter-irritants, alcoholic tonics, etc., have subdued the cough; with the exception of an occasional uneasiness about the chest, the condition of the patient seems greatly improved; only an abnormally rapid pulse justifies a suspicion that the smothered fire has not been wholly extinguished. A change of residence or plenty of out-door exercise may perhaps ratify the sham-cure. A normal pulse would give assurance that the masked fever has really subsided. But under less favorable circumstances an oppressive heat and a strange feeling of uneasiness will some day announce the approaching crisis of the latent disorder. Chills follow at shorter and shorter intervals, and at last a pricking pang in the region of the upper ribs reveals the seat of the affection. Breathing soon becomes so painful that the patient finds no rest in a horizontal position, but has to sit up in his bed, and may feel sorely tempted to relieve his distress by invoking the aid of the drug-gods. For believers in the remedial resources of Nature, pleurisy is, indeed, a crucial test of faith, and Dr. Isaac Jennings's observations on his experience during an acute attack of the disease deserve to be framed in every hygienic sanitarium.

"For twelve hours," says he, "breathing was at best laborious and painful, confining me to nearly an erect position in bed; but the distress occasioned by efforts at coughing was indescribable. The confidence of my wife in the 'let-alone' treatment, which had been strengthening for years, and had carried her unflinchingly through a number of serious indispositions, on this occasion faltered; and she begged me to let her send for a physician to bleed me or do something to give at least temporary relief; 'for,' said she, 'you can not live so.' In my own mind there was not the least vestige of misgiving respecting the course pursued.

"In view of the constitutional defect in the pulmonary department of my system, and the nature and severity of the symptoms, it appeared to me very doubtful whether the powers of life would hold out and be able to accomplish what they had undertaken and put me again upon my feet. But I felt perfectly satisfied that whatever could be done to good purpose would be done, by 'due course of law.' My mind, therefore, was perfectly at ease in trusting Nature's work in Nature's hands. There was no danger in the symptoms, let them run as high as they would. They constituted no part of the real difficulty, but grew out of it. The general movement which made them necessary was aiming directly at the removal of that difficulty. Instead, therefore, of being troubled with the idea that I could not live with such symptoms, my conviction was very strong that I could live better with them than without them.

"In the morning, ten or twelve hours from the beginning of the cold chill, there was some mitigation of suffering, which continued till afternoon, when there was a slight exacerbation of symptoms; but the heaviest part of the work was accomplished within the first twenty-four hours. From that time there was a gradual declension of painful symptoms, till the fifth day, when debility and expectoration constituted the bulk of the disease.

"Full bleeding at the commencement of the disease, followed by the other * break-up ' means usually employed in such affections, would have given me immediate relief, and, by continuing to ply active means as the work was urged on (for there would have been no stopping of it, short of stopping the action of the heart), the strongest, most distressing, and critical part of the disease might have been pushed forward to the fifth day; and I might even then possibly have recovered. But, granting that my life would have been spared, I suffered much less on the whole under the 'let alone' treatment than I should have done under a perturbating one, besides having the curative process conducted with more regularity, made shorter, and done up more effectually " ("Medical Reform," p. 312).

After the paroxysm of the disease has subsided, the pectoral fever can be alleviated by the free use of cold water and strict abstinence from solid food. Avoid over-warm bedclothing. By a load of warm covers alone a common catarrh can be aggravated into a hot fever till the blanket-smothered patient is awakened by the throbbing of a galloping pulse. Exercise would promote the discharge of the accumulated serum, but, while the patient is too sore to turn over in his bed, gymnastics are out of the question, and their effect must be accomplished by "passive exercise," manipulation of the thorax, and a swinging motion in a hammock or a rocking easy-chair. With the aid of fresh air and abstinence the remedies of the movement-cure might be entirely dispensed with, if the accumulation of purulent matter were the only risk, but in acute pleurisy there is a greater danger from another cause, namely, that the inflamed surface of the visceral pleura has a tendency to adhere to the lining of the thorax and thus obliterate the pleural cavity. The consequences of that result would be a permanent embarrassment of breathing, or even the total paralysis of the affected lung. Passive exercise and friction (rubbing the less affected parts of the chest with a bathing-brush) will, however, not fail to obviate that danger. As soon as Nature finds relief in a copious expectoration, the crisis of the disease is weathered, and further precautions may be limited to rest and a sparse but emulsive diet—a modicum of sweet cream, with oatmeal-gruel and stewed raisins. That pleurisy was formerly considered a most fatal disease can be more than sufficiently explained by the fatal measures of treatment which were then in vogue. Dr. Buchan's "Family Medical Library," not more than thirty years ago about the most popular pathological compend, contains the following directions: "In the beginning of a pleurisy the only efficient course is to make the patient stand up on the floor, while blood is drawn from a large orifice until he faints or is about falling.... If, after the first bleeding, the pain, with the other violent symptoms, should still continue, it will be necessary to take eight or nine ounces more. If the symptoms do not then abate, and the blood shows a strong buffy-coat, a third or even a fourth bleeding may be requisite.... Topical bleeding has also a good effect in this disease. It may be performed by applying a number of leeches to the parts affected, or by cupping, which is both a more certain and expeditious method than the other.... Then, take: Solution of acetated ammonia, three drachms; mint-water, one ounce; tincture of opium, twenty-five drops; sirup of tolu, two drachms; antimonial wine, thirty drops. Nothing is so certain to give speedy and permanent relief as a combination of ipecac, calomel, and opium." And in that form of the disease known as "bilious pleurisy," "emetics and mercurial cathartics are of the utmost importance.... Purgatives should be continued through the whole course of the disease;... a blister should be applied of sufficient size to embrace the whole breast"! ("Family Medical Library," pages 174, 183).

Croup is an obstruction of the upper air-tubes, induced by the lethargic influence of overfeeding and warm, impure air. How an overloaded stomach reacts on the functions of the respiratory organs, many adults have an opportunity to experience in the strangling sensations of a "nightmare," though the respiratory stimulus of the cool night-air generally helps to overcome such affections, especially if the sufferer can ease his lungs by a contraction of his arms or by turning over on his side. But infants are not only more grossly overfed than the most gluttonous adults, while the phlegm-producing quality of their food increases the danger of respiratory obstructions, but that danger is still aggravated by feeding their lungs on the sickening air of an overheated and ill-ventilated bedroom, and still further aggravated by swaddling and bandaging them in a way to prevent every motion that might help to ease their distress. Spasmodic croup generally occurs after the establishment of a plethoric diathesis—after persistent overfeeding has turned a baby into a mass of fat and fretful sickliness. Some night, usually after a heavy surfeit, the child is awakened by a feeling of suffocation and gasps for breath till the obstruction is removed by a violent fit of coughing. "Croup-sirup" (treacle and laudanum) subdues the symptoms by lethargizing the irritability for a little while, for soon a second and more violent fit has to complete the work of the first paroxysm by expelling the accumulated phlegm.

But a far more dangerous form of the disease is developed when the predisposing causes are aggravated by an inflammation of the larynx. Inflammatory croup, or exudative laryngitis,[2] does not occur unawares, but is preceded by a very peculiar cough, a hoarse, cough-like bark, mingled with strange wheezing and metallic sounds. The windpipe is congested, and in that note of warning appeals for relief from impure air and deliverance from the influence of a crapulent diet. Nine times out of ten the effect of its appeal is a dose of narcotic cough-medicine, more tightly-closed windows and a hotter stove. The process of surfeit in the mean while continues; the windpipe, already abnormally contracted by its inflamed condition, becomes less and less able to resist the obstructing influence of the accumulated phlegm; at night, when the exclusion of every breath of fresh air [3] has still further reduced the functional energy of the respiratory organs, a viscid matter rises in bubbles, and one of these bubbles, like a tenacious membrane, closes the tube of the larynx. Suffocation results, and, in the ensuing struggle for life, Nature has a very slim chance to prevail. In our Northern States alone, five or six thousand perish thus every year—killed by domestic contrivances as surely as the prisoners of Surajah Dowlah were killed by the architectural arrangements of the Black Hole. If the physician is only called in the last stage of the deliquium, inflammatory croup constitutes one of those exceptional cases where artificial causes of disease have to be met by artificial remedies. The far-gone exhaustion of the patient, a thin, expiring pulse, would indicate that tracheotomy, or the opening of the windpipe, offers the only hope of salvation. A violent, suffocating, and spasmodic cough would indicate that the expulsive efforts of Nature require the aid of a swift emetic—tartar or ipecacuanha.

But, if the symptoms of danger are heeded in time, croup is as curable as a common catarrh. As soon as the characteristic cough betrays the condition of the windpipe, the patient—infant or adult—should be reduced to two meals, the last one not later than four hours before sunset. Flesh-food, greasy made-dishes, narcotic drinks, as well as all kinds of alcoholic stimulants, should be strictly avoided. Before night the bed should be removed to a cool and carefully ventilated room. Families who have no alternative should not hesitate to open every window for at least fifteen minutes, and in the mean while compromise with their prejudices by carrying the child to the next neighbors, rather than bring it back before the air of the bedroom has been thoroughly purified. A draught of very cold air might possibly excite a cough that would precipitate the crisis of the disease, though by no means lessen the chances of a lucky issue. But more probably fresh air, whether cold or cool, would so re-enforce the remedial resources of Nature that the inflammation would subside in the course of a few days.

If in spite of such precautions a strangling-fit should occur at night, the child should be immediately raised to a half-upright position, by making the weight of the body rest on the knees, with the head slightly inclined (face downward), the elbows back, and the hands resting against the hips the position which a person would instinctively assume in the endeavor to aid an expulsive effort of the lungs. Between the paroxysms ease the chest by a quick forward-and-backward movement of the arms, and by persistent friction with a wet brush, applied to the neck and the upper ribs. Under the influence of these stimulants, combined with the invigorating tendency of fresh air, the organism will employ all its resources to the best advantage and soon relieve itself by a sort of retching cough. If the difficulty has not been aggravated by the use of "croup-sirup," the patient will rest at ease for the remaining hours of the night. A week may go by without a recurrence of the suffocating fit; but only the subsidence of the inflammation—indicated by the diminished hoarseness of the cough—gives a guarantee that the danger is past.

↑The correlation of damp weather and catarrhs can be explained by the fact that moisture lessens the modicum of fresh air which would otherwise penetrate a building in spite of closed windows. "All materials," says a correspondent of the "Revue des Deux Mondes," "become impermeable to the air when they are wet. It has been found less easy to drive moisture through bricks and mortar than to make air pass through them; only a few drops of the liquid can be made to appear on the opposite surface. Water is therefore not easy to dislodge from the pores it has occupied, and is removed at most very slowly by evaporation. But, when water stops the pores, it prevents the air from circulating through them a mischievous effect upon the permeability of building materials."—(Vide Popular Science Monthly" for December, 1883, p. 170.)

↑"I lately attended an infant, whom I found muffled up over head and ears in many folds of flannel, though it was in the middle of June. I begged for a little free air to the poor creature; but, though this indulgence was granted during my stay, I found it always on my return in the same situation. Death, as might have been expected, soon freed the infant from all its miseries; but it was not in my power to free the minds of its parents from those prejudices which proved fatal to their child " (Dr. G. G. Norwood, " Management of Children," p. 619).